6 ms·

What was the Golden Age of Antibiotics, and how can we spark a new one?

66 points by surprisetalk 2y ago

chiph 2y ago
Stop administering them whenever anyone gets a sniffle so they stay effective longer. Also firmly separate veterinary antibiotic classes from human antibiotics so that the ones intended for humans stay effective longer.
- Spivak 2y ago
  The problem with a policy like this is that in practice rich people will get antibiotics whenever they (we? hn is well off enough to cont as rich for this perk) want and everyone else suffers. It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else. This will deal double damage if you try to enforce any kind of quota. I can afford to go to a nice doctor who will prioritize my comfort and who will literally tell me what to say to meet the criteria but anyone with less choice will have to fight.
  - whatshisface 2y ago
    Judging the need for antibiotics is not some kind of personality quiz, bacteria can be cultured. (I'm not sure why they don't usually do it.)
    - trallnag 2y ago
      Takes time and costs money. Problematic for an already strained health care system. And as a patient I prefer to get treated immediately for my painful skin infection instead of waiting a day or so for results to arrive
  - queuep 2y ago
    Sure, but on a global scale the rich are a small percentage of the world population. Some countries are very restrictive on prescribing antibiotics (almost too strict) and it feels like it falls flat as you can get it over the counter in a lot of places.
    - _zoltan_ 2y ago
      In Switzerland it's tough to get antibiotics unless you absolutely need them. Even when I had a lung issue for 2 weeks I had to beg to get antibiotics. Weird. And they are not available over the counter. In Hungary, on the other hand, they hand them out like candies. So yes, the solution was to import them from Hungary. :-)
      - epcoa 2y ago
        > get antibiotics unless you absolutely need them. Yes that’s exactly how it should be. They are not at all benign misprescribed. > Even when I had a lung issue for 2 weeks I had to beg to get antibiotics. Was there any evidence of a bacterial infection or did they just give in? 2 weeks is not a long time for a viral respiratory illness either.
        _zoltan_ 2y ago
        they didn't give in, but I actually checked hospital internal guidelines for doctors, and it states 3 weeks. They could have done some more tests or whatever, as it was maybe the worst lung issue I've had and I was really miserable. I knew that antibiotics would help, and they did. I sourced them myself. You could say lucky guess, but after I complained to my health insurer about the bad doctor's visit, they covered the cost fully without any dispute, so they must have agreed with me with at least about maybe running some more tests...
        gus_massa 2y ago
        If it was "only" [1] a viral disease, it should dissapear even without antibiotics after a week or two. So perhaps your body solved the problem alone, while you took antibiotics that had no effect. This is a real posibility and is a real problem to test how useful the medicines are. So all serious studies use a control group [2] to compare the rate of spontanous healing with the rate of healing with the antibiotic. [1] Some virus are very nasty and can kill you. People confuse the common cold andd the flu, but usualy the flu is much worse. [2] Preferabely a preregistered double blind randomized control group, becuse there are a lot of other problem that can cause a false result.
  - epcoa 2y ago
    > I can afford to go to a nice doctor If your doctor is giving you antibiotics for clearly viral illnesses they are doing a disservice to you, it isn’t actually nice. It’s not like I’ve ever seen some systemic withholding of antibiotics when they are clearly indicated - quite the opposite, some of the worst areas for resistance are the poorest. They aren’t without other side effects, resistance being only one. Also you have it backwards, the racist thing to do is to just prescribe the antibiotics, since they are dirt cheap, cost me (the provider) nothing, and makes the person whose skin color I possibly don’t like get out of my office faster (if not racism, pragmatism to see too many patients). Racism alone is not necessarily the only explanation, but antibiotic over prescription/use tends to be associated with poverty. Well run antibiotic stewardship is a conceit of the most affluent health systems.
    - deleted 2y ago
      [deleted]
  - PessimalDecimal 2y ago
    > It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else. You're trying to shoehorn an unfounded accusation of racism into a discussion about antibiotics. This sh*t is tiresome.
    - Spivak 2y ago
      We're not talking about antibiotics, we're talking about policy. And any discussion of policy requires systems level thinking. I'm not accusing anyone of racism, I'm white and reasonably affluent idgaf, I genuinely believe the policy being proposed would be selfishly better for me personally. This is the reality of medical care right now in the US what are you talking about? https://www.hopkinsmedicine.org/news/articles/2021/06/physicians-more-likely-to-doubt-black-patients https://www.hopkinsmedicine.org/news/articles/2021/06/physic... The existing bias in the medical system along with policy that asks doctors to doubt more patients has a pretty damn predictable outcome.
    - HeatrayEnjoyer 2y ago
      That isn't true at all.
  - chmod775 2y ago
    > I can afford to go to a nice doctor who will prioritize my comfort If they actually do, they'll probably not give you antibiotics, which are associated with many undesirable short and long-term health outcomes. Taking antibiotics for mere "comfort" in the hopes they do anything is not a good idea. Even if you were absolutely sure they will help it may still not be worth it.
- PittleyDunkin 2y ago
  > Stop administering them whenever anyone gets a sniffle This hasn't been true for most of my life and it remains a serious concern. Not to mention antibiotics often come with seriously nasty side effects of their own, so you as the patient even wanting the best outcome shouldn't even necessarily want antibiotics.
  - foobiekr 2y ago
    It is not an issue in the US. It is a massive, massive issue in some very large countries.
    - PittleyDunkin 2y ago
      Ahh yes, very fair.
    - ipaddr 2y ago
      It is still a big issue in the US even if it is more massive elsewhere plus we use it in the meat industry to the point where certain types of antibiotics cannot be used anymore.
      - foobiekr 2y ago
        If you look at any map of antibiotic resistance, it is quite obvious where the problem is.
- fnordpiglet 2y ago
  In most of the world, by population, the regulatory structure of society is so weak that there is no way to achieve this. Antibiotics are available without prescription, licensed doctors of skill are rare, and patients are insistent on antibiotics for everything. In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable. But in most of the developing world it’s prevalent to over administer antibiotics either through clinics are directly at the unregulated pharmacies.
  - AyyEye 2y ago
    > In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable. Antibiotics as 'consolation prizes' is definitely a thing.
    - AngryData 2y ago
      Yeah ive seen it myself, and part of it is driven by people's demands and expectations to receive treatment when they go to a doctor. Even if they go for very minor sniffles, many people will not return to the same doctor later if they are given nothing other than what boils down to "stop being a wimp and rest for a few days because nothing I do is going to actually help." Especially when the visit itself comes at a decent cost to the patient (in the US atleast). So doctors who overprescribe medication are more profitable for their owners and have higher demand from patients and are incentivized to do so, while doctors following the science more closely will be less profitable and have lower demand. Better education on health and healthcare would help, but certainly not come anywhere near eliminating the incentives to over prescribe versus under prescribe antibiotics and medications. Perhaps more placebo medications could help, but that has its own litany of problems in making people believe they are receiving a medication when they are not, and numerous patients might view it as being scammed even if a placebo is the best thing that could be given to them.
  - christkv 2y ago
    At least in the EU they have reduced prescriptions a lot. They don't write antibiotics prescriptions if you have bronchitis unless you have a fever or if it does not improve over a span of days. 10 years ago they would just give you a wide spectrum antibiotic. They still suck on just taking a swab and culture.
PessimalDecimal 2y ago
Overuse and misuse of antiobiotics isn't really a US thing. https://resistancemap.onehealthtrust.org/AntibioticResistance.php https://resistancemap.onehealthtrust.org/AntibioticResistanc... is a nice, interactive map showing where the majority of the resistant strains are found. Any effort to curtail the emergence of antibiotic resistant bacteria will require coordinated global action, which means it's highly unlikely to happen.
- api 2y ago
  Agricultural overuse is also a major vector.
  - bsder 2y ago
    So why is India such a resistance hotspot?
    - samarthr1 2y ago
      Lax enforcement on class H drugs (the non otc, but not addictive stuff), which spans combiflam to augmentin... We also have pharmacists who act as doctors in a pinch and reccomend drugs.
      - fakedang 2y ago
        > We also have pharmacists who act as doctors in a pinch and reccomend drugs. Honestly this is a very granular problem I think, simply because doctors are so expensive in quite a few locations. Wherever doctors are affordable or accessible, I've never seen a pharmacist play doctor and push their medication. Kerala, Himachal, Goa, places with good accessible govt clinics and hospitals, etc.
- metalman 2y ago
  wrong the over prescribing and agricultural use of antibiotics, started and was definitly more prevelant in the US. Largely due to wealth and availibility. And in fact ALL of the modern chemical agriculture practices that have "unintended consequences" got started in the US. Over use of pestisides, herbisides, and fertilisers. That other countrys followed after, at the prompting of US govrnment trade policy , and to the benifit of US industry, is hardly grounds to shift blame. What would be relevant, is a map, a nice interactive one, that overlayed profit flow, from the areas where "resistent strains" are found. This and many other of the worlds problems can be summed up, under the heading of "exporting contradictions" and reaping the profits. DDT is still made in the US, for export only.
nimish 2y ago
Do we need one? Quarantine them from the countries that can't or won't enforce discipline on prescription and the problem solves itself.
- bigmadshoe 2y ago
  Insane take. What about the people with life threatening infections in those countries? Just collateral damage?
  - voidfunc 2y ago
    Sucks to be them?
  - Findecanor 2y ago
    You could argue that in that case the people deserving the most blame would be the people in charge for that country's medical system not having implemented proper antibiotic discipline to qualify for the antibiotic. The same rules would have to apply to all.
    - BriggyDwiggs42 2y ago
      Why would we condemn a population of innocents on the basis of bad leaders. This is very bad logic; it leads to very bad things.
- old_king_log 2y ago
  This poster has +2551 karma. Stay classy HN.
aurizon 2y ago
Doctors and their 'fee for service' mentality are, in part, at the roof of this. They know an antibiotic is a waste of $$ for a viral disease, but the money meter ticks upwards.
- nradov 2y ago
  There are problems with the fee-for-service financial model but this isn't one of them. The doctor will be paid the same for the office visit regardless of whether they prescribe or not. The money for any antibiotic goes to the pharmacy, pharmacy benefit manager, and pharmaceutical company.
  - eszed 2y ago
    You're neglecting customer loyalty, and patient throughput. A doctor who (correctly) says "there's nothing I can do for you; ger some rest and you'll get better" will be seen as "uncaring" and patients will de-register from their practice. They'll also have to spend time arguing / "educating" obstreperous patients, and earn less. A doctor who writes a (perhaps unwarranted) prescription finishes the visit faster, and gets better patient reviews. I'm not making this up. A medical provider up-thread made this point.
    - nradov 2y ago
      That's a separate issue unrelated to the fee-for-service financial model. The same issue would still exist under any model where patients can pick their providers, including capitated VBC.
      - aurizon 2y ago
        Makes me wonder why there is such a death grip on the fee for service model?
        nradov 2y ago
        Fee-or-service is the simplest and lowest risk model for providers. Anyone can submit a claim using a standard EDI transaction or paper form. Capitated models only work for larger health systems that can deliver most common services under one roof, and that have the necessary IT and actuarial competence to price risk for a patient population accurately. There is an emerging set of technical standards which can make this a bit easier. https://www.hl7.org/about/davinci/ https://www.hl7.org/about/davinci/
fnordpiglet 2y ago
I think the UN or governments themselves should get into the business of bad business medicine. The fact drug companies are prioritizing research of chronic medications is an obvious outcome of our current structure. The government or quasi governmental organization can continue to subsidize industry research and buy licenses for discoveries they then productionize at cost. This wouldn’t directly compete with industry and it would incentivize public private research across large areas of otherwise unprofitable areas of medicine such as this.
- evrimoztamur 2y ago
  This is what the Turkish government has been up to and it has driven drug costs, and therefore overall costs of healthcare provision and insurance, down. More countries should nationalise production of generics, it works.
  - selimthegrim 2y ago
    Does the cost of letting everyone see a specialist whenever they want cancel that out?
    - sfn42 2y ago
      It's well known that the US healthcare system costs more for the taxpayer than single payer systems, while also bankrupting those unfortunate enough to get hurt/sick and requiring ridiculous monthly payments for the individual on top. So I wouldn't worry about that. Healthcare is not nearly as expensive as US providers make it. Single payer systems aren't perfect either but from my perspective having lived with one my entire life it works fine. I have always gotten the help I need in reasonable time. I also have private options if I want to spend money, and they're far cheaper than private options in the US. But so far I haven't felt any need for it. A colleague was recently diagnosed with testicular cancer, he was admitted for surgery within a few days and back to work in a few weeks. Didn't cost him anything. And just to reiterate - this is cheaper per capita, just comparing tax costs, than the US system and that's ignoring insurance premiums and copays etc.
johnea 2y ago
#1 thing that could be done in the US would be to stop using so many of them. Especially in agricultural animals...
Faaak 2y ago
Sad that the article is not talking about bacteriophages[1]. Basically viruses that infect other bacteria. The world is full of them (and even virophages: viruses that infect other viruses). The soviet union started experimenting them, and they seem to be used to treat hard-to-cure infections like Staphylococcus aureus, but I guess it died down somehow? [1]: https://en.wikipedia.org/wiki/Bacteriophage https://en.wikipedia.org/wiki/Bacteriophage
- MoreMoore 2y ago
  From the bits and pieces I've heard, the problem is one of scaling. Bacteriophages had to be made bespoke for a specific patient.
  - dennis_jeeves2 2y ago
    I've heard that for stubborn cases it works really well. It's true it does not lend itself to mass manufacture the way antibiotics do but I believe, a typical lab with the right knowledge/equipment/resources should be able to do it. I saw a documentary a long time back where they do it Georgia, not sure how legit it is.
- dennis_jeeves2 2y ago
  >but I guess it died down somehow? I've heard that it lives on in Georgia.
  - yawnxyz 2y ago
    It lives on everywhere! Lots of labs working on it in the US, we started a clinical trial in Australia called Phage Australia. As the other post says, it's effective but cost prohibitive at scale, and biologics are a pain. It'll get here, but we need way better tools to lower the costs.
    - dennis_jeeves2 2y ago
      Hey thanks, that's cause for optimism. Can you very, very briefly tell me what the biologics are in the case - cultures?
pazimzadeh 2y ago
Most new antibiotics come from soil bacteria. We got all the low hanging fruits, now you need to dig through tons of soil to find something new., Better culture methods would make it easier to run experiments instead of relying on genome rather than relying on /cloning/expression in E. coli.
vouaobrasil 2y ago
Is there a danger that with more sophisticated antibiotics, we could eventually eradicate too much good bacteria?
- xandrius 2y ago
  More sophisticated, I'd expect more precision not just more of the same (and bad) old. Now we just wreck havoc of absolutely anything which is a bacteria, it would be nice to be able to select the typology.
cyberax 2y ago
This article misses several new antibiotic classes that are emerging: macrocyclic peptides, and a bunch of compounds from unculturable soil bacteria (clovibactin, teixobactin, etc.)
christkv 2y ago
We have a whole arsenal of old antibiotics no longer in use that are candidates for redevelopment. As bacteria develop resistance to newer antibiotics they make evolution tradeoffs which bring back into play older antibiotics. https://pmc.ncbi.nlm.nih.gov/articles/PMC4242550/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4242550/ I think cocktails will be used (if they are not already in use) to attack the bacteria from different angles at the same time reducing the likelihood of developing resistance. Another thing is better protocols. More quick testing before prescription so you use more targeted antibiotics and reduce the use of wide spectrum antibiotics.
wdwvt1 2y ago
The comments on this article take for granted that agricultural use of antibiotics is a key driver of the emergence of antimicrobial resistance (AMR). This is an intuitive and popular explanation, but the magnitude of this effect is not well established. As an example, [0] is of the best reviews available on the contribution of non-therapeutic antibiotic usage in animal feeds to AMR. Despite the large amount of evidence cited, the authors can't conclude that a ban on animal use of antibiotic class X would lead to Y more years before resistance to X emerges/spreads. It seems well established that banning use of certain antibiotics as a feed additive would slow the emergence of resistance, but that magnitude of that effect seems totally unknown. There is perhaps a strong precautionary principle argument to be made for banning use of medically important antibiotics as feed additives, but we should be cautious in making any firm conclusions about how much that would impact the medically useful lifetime of existing or new antibiotics. In a similar vein, the idea that commercial prospects for antibiotic development are limited because agricultural use would cause fast emergence is not supported from what I can find. A very good recent paper [1] discussing failures of antibiotic development in the US in the last 20 years highlights trial, regulatory, and commercial hurdles as key roadblocks to successful commercialization of antibiotics. [0] https://journals.asm.org/doi/full/10.1128/cmr.00002-11 https://journals.asm.org/doi/full/10.1128/cmr.00002-11 [1] https://www.nature.com/articles/s41599-024-03452-0 https://www.nature.com/articles/s41599-024-03452-0
at_a_remove 2y ago
I believe that this is a technical issue now. In a more ideal world, procedure, legislation, regulation, protocols would be followed to slow the growth of antibiotic resistance, but there are just too many Defectors for that approach. It's in nerd hands now ...
cchi_co 2y ago
[dead]
rganesan 2y ago
I posted to HN an article about 3 new antibiotics discovered in India and it didn't get much attention :-(. https://www.bbc.co.uk/news/articles/c80vrjkkrero https://www.bbc.co.uk/news/articles/c80vrjkkrero
ashoeafoot 2y ago
What need a cycle, as if a bug traverses immunity ,it looses resistance to the opposite of the cycle
helpfulContrib 2y ago
[dead]
cleanerbob 2y ago
[dead]

66 points by surprisetalk 2y ago

Stop administering them whenever anyone gets a sniffle so they stay effective longer. Also firmly separate veterinary antibiotic classes from human antibiotics so that the ones intended for humans stay effective longer.

Spivak 2y ago
The problem with a policy like this is that in practice rich people will get antibiotics whenever they (we? hn is well off enough to cont as rich for this perk) want and everyone else suffers. It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else. This will deal double damage if you try to enforce any kind of quota. I can afford to go to a nice doctor who will prioritize my comfort and who will literally tell me what to say to meet the criteria but anyone with less choice will have to fight.
- whatshisface 2y ago
  Judging the need for antibiotics is not some kind of personality quiz, bacteria can be cultured. (I'm not sure why they don't usually do it.)
  - trallnag 2y ago
    Takes time and costs money. Problematic for an already strained health care system. And as a patient I prefer to get treated immediately for my painful skin infection instead of waiting a day or so for results to arrive
- queuep 2y ago
  Sure, but on a global scale the rich are a small percentage of the world population. Some countries are very restrictive on prescribing antibiotics (almost too strict) and it feels like it falls flat as you can get it over the counter in a lot of places.
  - _zoltan_ 2y ago
    In Switzerland it's tough to get antibiotics unless you absolutely need them. Even when I had a lung issue for 2 weeks I had to beg to get antibiotics. Weird. And they are not available over the counter. In Hungary, on the other hand, they hand them out like candies. So yes, the solution was to import them from Hungary. :-)
    - epcoa 2y ago
      > get antibiotics unless you absolutely need them. Yes that’s exactly how it should be. They are not at all benign misprescribed. > Even when I had a lung issue for 2 weeks I had to beg to get antibiotics. Was there any evidence of a bacterial infection or did they just give in? 2 weeks is not a long time for a viral respiratory illness either.
      - _zoltan_ 2y ago
        they didn't give in, but I actually checked hospital internal guidelines for doctors, and it states 3 weeks. They could have done some more tests or whatever, as it was maybe the worst lung issue I've had and I was really miserable. I knew that antibiotics would help, and they did. I sourced them myself. You could say lucky guess, but after I complained to my health insurer about the bad doctor's visit, they covered the cost fully without any dispute, so they must have agreed with me with at least about maybe running some more tests...
        gus_massa 2y ago
        If it was "only" [1] a viral disease, it should dissapear even without antibiotics after a week or two. So perhaps your body solved the problem alone, while you took antibiotics that had no effect. This is a real posibility and is a real problem to test how useful the medicines are. So all serious studies use a control group [2] to compare the rate of spontanous healing with the rate of healing with the antibiotic. [1] Some virus are very nasty and can kill you. People confuse the common cold andd the flu, but usualy the flu is much worse. [2] Preferabely a preregistered double blind randomized control group, becuse there are a lot of other problem that can cause a false result.
- epcoa 2y ago
  > I can afford to go to a nice doctor If your doctor is giving you antibiotics for clearly viral illnesses they are doing a disservice to you, it isn’t actually nice. It’s not like I’ve ever seen some systemic withholding of antibiotics when they are clearly indicated - quite the opposite, some of the worst areas for resistance are the poorest. They aren’t without other side effects, resistance being only one. Also you have it backwards, the racist thing to do is to just prescribe the antibiotics, since they are dirt cheap, cost me (the provider) nothing, and makes the person whose skin color I possibly don’t like get out of my office faster (if not racism, pragmatism to see too many patients). Racism alone is not necessarily the only explanation, but antibiotic over prescription/use tends to be associated with poverty. Well run antibiotic stewardship is a conceit of the most affluent health systems.
  - deleted 2y ago
    [deleted]
- PessimalDecimal 2y ago
  > It will for sure also summon the racist underbelly of the US where doctors will believe white sympathetic patients when they say how long they've been sick and question everyone else. You're trying to shoehorn an unfounded accusation of racism into a discussion about antibiotics. This sh*t is tiresome.
  - Spivak 2y ago
    We're not talking about antibiotics, we're talking about policy. And any discussion of policy requires systems level thinking. I'm not accusing anyone of racism, I'm white and reasonably affluent idgaf, I genuinely believe the policy being proposed would be selfishly better for me personally. This is the reality of medical care right now in the US what are you talking about? https://www.hopkinsmedicine.org/news/articles/2021/06/physicians-more-likely-to-doubt-black-patients https://www.hopkinsmedicine.org/news/articles/2021/06/physic... The existing bias in the medical system along with policy that asks doctors to doubt more patients has a pretty damn predictable outcome.
  - HeatrayEnjoyer 2y ago
    That isn't true at all.
- chmod775 2y ago
  > I can afford to go to a nice doctor who will prioritize my comfort If they actually do, they'll probably not give you antibiotics, which are associated with many undesirable short and long-term health outcomes. Taking antibiotics for mere "comfort" in the hopes they do anything is not a good idea. Even if you were absolutely sure they will help it may still not be worth it.
PittleyDunkin 2y ago
> Stop administering them whenever anyone gets a sniffle This hasn't been true for most of my life and it remains a serious concern. Not to mention antibiotics often come with seriously nasty side effects of their own, so you as the patient even wanting the best outcome shouldn't even necessarily want antibiotics.
- foobiekr 2y ago
  It is not an issue in the US. It is a massive, massive issue in some very large countries.
  - PittleyDunkin 2y ago
    Ahh yes, very fair.
  - ipaddr 2y ago
    It is still a big issue in the US even if it is more massive elsewhere plus we use it in the meat industry to the point where certain types of antibiotics cannot be used anymore.
    - foobiekr 2y ago
      If you look at any map of antibiotic resistance, it is quite obvious where the problem is.
fnordpiglet 2y ago
In most of the world, by population, the regulatory structure of society is so weak that there is no way to achieve this. Antibiotics are available without prescription, licensed doctors of skill are rare, and patients are insistent on antibiotics for everything. In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable. But in most of the developing world it’s prevalent to over administer antibiotics either through clinics are directly at the unregulated pharmacies.
- AyyEye 2y ago
  > In most developed countries doctors are already parsimonious with antibiotics and generally won’t prescribe them unless an infection is observable. Antibiotics as 'consolation prizes' is definitely a thing.
  - AngryData 2y ago
    Yeah ive seen it myself, and part of it is driven by people's demands and expectations to receive treatment when they go to a doctor. Even if they go for very minor sniffles, many people will not return to the same doctor later if they are given nothing other than what boils down to "stop being a wimp and rest for a few days because nothing I do is going to actually help." Especially when the visit itself comes at a decent cost to the patient (in the US atleast). So doctors who overprescribe medication are more profitable for their owners and have higher demand from patients and are incentivized to do so, while doctors following the science more closely will be less profitable and have lower demand. Better education on health and healthcare would help, but certainly not come anywhere near eliminating the incentives to over prescribe versus under prescribe antibiotics and medications. Perhaps more placebo medications could help, but that has its own litany of problems in making people believe they are receiving a medication when they are not, and numerous patients might view it as being scammed even if a placebo is the best thing that could be given to them.
- christkv 2y ago
  At least in the EU they have reduced prescriptions a lot. They don't write antibiotics prescriptions if you have bronchitis unless you have a fever or if it does not improve over a span of days. 10 years ago they would just give you a wide spectrum antibiotic. They still suck on just taking a swab and culture.

PessimalDecimal 2y ago

Overuse and misuse of antiobiotics isn't really a US thing. https://resistancemap.onehealthtrust.org/AntibioticResistance.php https://resistancemap.onehealthtrust.org/AntibioticResistanc... is a nice, interactive map showing where the majority of the resistant strains are found. Any effort to curtail the emergence of antibiotic resistant bacteria will require coordinated global action, which means it's highly unlikely to happen.

api 2y ago
Agricultural overuse is also a major vector.
- bsder 2y ago
  So why is India such a resistance hotspot?
  - samarthr1 2y ago
    Lax enforcement on class H drugs (the non otc, but not addictive stuff), which spans combiflam to augmentin... We also have pharmacists who act as doctors in a pinch and reccomend drugs.
    - fakedang 2y ago
      > We also have pharmacists who act as doctors in a pinch and reccomend drugs. Honestly this is a very granular problem I think, simply because doctors are so expensive in quite a few locations. Wherever doctors are affordable or accessible, I've never seen a pharmacist play doctor and push their medication. Kerala, Himachal, Goa, places with good accessible govt clinics and hospitals, etc.
metalman 2y ago
wrong the over prescribing and agricultural use of antibiotics, started and was definitly more prevelant in the US. Largely due to wealth and availibility. And in fact ALL of the modern chemical agriculture practices that have "unintended consequences" got started in the US. Over use of pestisides, herbisides, and fertilisers. That other countrys followed after, at the prompting of US govrnment trade policy , and to the benifit of US industry, is hardly grounds to shift blame. What would be relevant, is a map, a nice interactive one, that overlayed profit flow, from the areas where "resistent strains" are found. This and many other of the worlds problems can be summed up, under the heading of "exporting contradictions" and reaping the profits. DDT is still made in the US, for export only.

nimish 2y ago

Do we need one? Quarantine them from the countries that can't or won't enforce discipline on prescription and the problem solves itself.

bigmadshoe 2y ago
Insane take. What about the people with life threatening infections in those countries? Just collateral damage?
- voidfunc 2y ago
  Sucks to be them?
- Findecanor 2y ago
  You could argue that in that case the people deserving the most blame would be the people in charge for that country's medical system not having implemented proper antibiotic discipline to qualify for the antibiotic. The same rules would have to apply to all.
  - BriggyDwiggs42 2y ago
    Why would we condemn a population of innocents on the basis of bad leaders. This is very bad logic; it leads to very bad things.
old_king_log 2y ago
This poster has +2551 karma. Stay classy HN.

aurizon 2y ago

Doctors and their 'fee for service' mentality are, in part, at the roof of this. They know an antibiotic is a waste of $$ for a viral disease, but the money meter ticks upwards.

nradov 2y ago
There are problems with the fee-for-service financial model but this isn't one of them. The doctor will be paid the same for the office visit regardless of whether they prescribe or not. The money for any antibiotic goes to the pharmacy, pharmacy benefit manager, and pharmaceutical company.
- eszed 2y ago
  You're neglecting customer loyalty, and patient throughput. A doctor who (correctly) says "there's nothing I can do for you; ger some rest and you'll get better" will be seen as "uncaring" and patients will de-register from their practice. They'll also have to spend time arguing / "educating" obstreperous patients, and earn less. A doctor who writes a (perhaps unwarranted) prescription finishes the visit faster, and gets better patient reviews. I'm not making this up. A medical provider up-thread made this point.
  - nradov 2y ago
    That's a separate issue unrelated to the fee-for-service financial model. The same issue would still exist under any model where patients can pick their providers, including capitated VBC.
    - aurizon 2y ago
      Makes me wonder why there is such a death grip on the fee for service model?
      - nradov 2y ago
        Fee-or-service is the simplest and lowest risk model for providers. Anyone can submit a claim using a standard EDI transaction or paper form. Capitated models only work for larger health systems that can deliver most common services under one roof, and that have the necessary IT and actuarial competence to price risk for a patient population accurately. There is an emerging set of technical standards which can make this a bit easier. https://www.hl7.org/about/davinci/ https://www.hl7.org/about/davinci/

fnordpiglet 2y ago

I think the UN or governments themselves should get into the business of bad business medicine. The fact drug companies are prioritizing research of chronic medications is an obvious outcome of our current structure. The government or quasi governmental organization can continue to subsidize industry research and buy licenses for discoveries they then productionize at cost. This wouldn’t directly compete with industry and it would incentivize public private research across large areas of otherwise unprofitable areas of medicine such as this.

evrimoztamur 2y ago
This is what the Turkish government has been up to and it has driven drug costs, and therefore overall costs of healthcare provision and insurance, down. More countries should nationalise production of generics, it works.
- selimthegrim 2y ago
  Does the cost of letting everyone see a specialist whenever they want cancel that out?
  - sfn42 2y ago
    It's well known that the US healthcare system costs more for the taxpayer than single payer systems, while also bankrupting those unfortunate enough to get hurt/sick and requiring ridiculous monthly payments for the individual on top. So I wouldn't worry about that. Healthcare is not nearly as expensive as US providers make it. Single payer systems aren't perfect either but from my perspective having lived with one my entire life it works fine. I have always gotten the help I need in reasonable time. I also have private options if I want to spend money, and they're far cheaper than private options in the US. But so far I haven't felt any need for it. A colleague was recently diagnosed with testicular cancer, he was admitted for surgery within a few days and back to work in a few weeks. Didn't cost him anything. And just to reiterate - this is cheaper per capita, just comparing tax costs, than the US system and that's ignoring insurance premiums and copays etc.

johnea 2y ago

#1 thing that could be done in the US would be to stop using so many of them. Especially in agricultural animals...

Faaak 2y ago

Sad that the article is not talking about bacteriophages[1]. Basically viruses that infect other bacteria. The world is full of them (and even virophages: viruses that infect other viruses). The soviet union started experimenting them, and they seem to be used to treat hard-to-cure infections like Staphylococcus aureus, but I guess it died down somehow? [1]: https://en.wikipedia.org/wiki/Bacteriophage https://en.wikipedia.org/wiki/Bacteriophage

MoreMoore 2y ago
From the bits and pieces I've heard, the problem is one of scaling. Bacteriophages had to be made bespoke for a specific patient.
- dennis_jeeves2 2y ago
  I've heard that for stubborn cases it works really well. It's true it does not lend itself to mass manufacture the way antibiotics do but I believe, a typical lab with the right knowledge/equipment/resources should be able to do it. I saw a documentary a long time back where they do it Georgia, not sure how legit it is.
dennis_jeeves2 2y ago
>but I guess it died down somehow? I've heard that it lives on in Georgia.
- yawnxyz 2y ago
  It lives on everywhere! Lots of labs working on it in the US, we started a clinical trial in Australia called Phage Australia. As the other post says, it's effective but cost prohibitive at scale, and biologics are a pain. It'll get here, but we need way better tools to lower the costs.
  - dennis_jeeves2 2y ago
    Hey thanks, that's cause for optimism. Can you very, very briefly tell me what the biologics are in the case - cultures?

pazimzadeh 2y ago

Most new antibiotics come from soil bacteria. We got all the low hanging fruits, now you need to dig through tons of soil to find something new., Better culture methods would make it easier to run experiments instead of relying on genome rather than relying on /cloning/expression in E. coli.

vouaobrasil 2y ago

Is there a danger that with more sophisticated antibiotics, we could eventually eradicate too much good bacteria?

xandrius 2y ago
More sophisticated, I'd expect more precision not just more of the same (and bad) old. Now we just wreck havoc of absolutely anything which is a bacteria, it would be nice to be able to select the typology.

cyberax 2y ago

This article misses several new antibiotic classes that are emerging: macrocyclic peptides, and a bunch of compounds from unculturable soil bacteria (clovibactin, teixobactin, etc.)

christkv 2y ago

We have a whole arsenal of old antibiotics no longer in use that are candidates for redevelopment. As bacteria develop resistance to newer antibiotics they make evolution tradeoffs which bring back into play older antibiotics. https://pmc.ncbi.nlm.nih.gov/articles/PMC4242550/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4242550/ I think cocktails will be used (if they are not already in use) to attack the bacteria from different angles at the same time reducing the likelihood of developing resistance. Another thing is better protocols. More quick testing before prescription so you use more targeted antibiotics and reduce the use of wide spectrum antibiotics.

wdwvt1 2y ago

The comments on this article take for granted that agricultural use of antibiotics is a key driver of the emergence of antimicrobial resistance (AMR). This is an intuitive and popular explanation, but the magnitude of this effect is not well established. As an example, [0] is of the best reviews available on the contribution of non-therapeutic antibiotic usage in animal feeds to AMR. Despite the large amount of evidence cited, the authors can't conclude that a ban on animal use of antibiotic class X would lead to Y more years before resistance to X emerges/spreads. It seems well established that banning use of certain antibiotics as a feed additive would slow the emergence of resistance, but that magnitude of that effect seems totally unknown. There is perhaps a strong precautionary principle argument to be made for banning use of medically important antibiotics as feed additives, but we should be cautious in making any firm conclusions about how much that would impact the medically useful lifetime of existing or new antibiotics. In a similar vein, the idea that commercial prospects for antibiotic development are limited because agricultural use would cause fast emergence is not supported from what I can find. A very good recent paper [1] discussing failures of antibiotic development in the US in the last 20 years highlights trial, regulatory, and commercial hurdles as key roadblocks to successful commercialization of antibiotics. [0] https://journals.asm.org/doi/full/10.1128/cmr.00002-11 https://journals.asm.org/doi/full/10.1128/cmr.00002-11 [1] https://www.nature.com/articles/s41599-024-03452-0 https://www.nature.com/articles/s41599-024-03452-0

at_a_remove 2y ago

I believe that this is a technical issue now. In a more ideal world, procedure, legislation, regulation, protocols would be followed to slow the growth of antibiotic resistance, but there are just too many Defectors for that approach. It's in nerd hands now ...

cchi_co 2y ago

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rganesan 2y ago

I posted to HN an article about 3 new antibiotics discovered in India and it didn't get much attention :-(. https://www.bbc.co.uk/news/articles/c80vrjkkrero https://www.bbc.co.uk/news/articles/c80vrjkkrero

ashoeafoot 2y ago

What need a cycle, as if a bug traverses immunity ,it looses resistance to the opposite of the cycle

helpfulContrib 2y ago

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cleanerbob 2y ago

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